Dialysis challenges outlined

Poor access to surgery forces the renal service into a
''vicious cycle'' in which patients are not always prepared
surgically for home dialysis, which then pressures hospital
services, Dunedin Hospital nephrologist Dr John Schollum said
yesterday.

Dr Schollum was part of a delegation that addressed the
Southern District Health Board's hospital advisory committee
in Invercargill about the service's challenges. The South
Island is a world leader in home dialysis, used by more than
95% of its dialysis patients, compared with about 40% in the
North Island, and much lower rates overseas.

Home dialysis is about half the cost, or less, of dialysis in
a clinic.

Faced with an 8% year-on-year increase in demand, the
dialysis service was ''on the edge'', Dr Schollum said.
Patients identified for dialysis would ideally have early
fistula surgery to prepare them, so they made a smooth
transition, and avoided urgent procedures and hospital stays
later.

Fistula surgery connects a vein and an artery. These were
frequently carried out six to nine months later than they
should be, because surgeons did not have dedicated time for
them.

Depending on where on the body a fistula was carried out,
some of them ought to be transferred to day surgery, he said.

The service also wants more resources to co-ordinate
transplants. By properly identifying subjects, some patients
might avoid dialysis, and the cost of dialysis rapidly
exceeded that of a transplant.

Dunedin nephrologist Prof Rob Walker said too many renal
patients were ''bumped off'' acute surgery slots, sometimes
waiting several days even for an urgent procedure. As well as
being less desirable for the patient's health, it meant
highly expensive materials were used to treat them while they
waited.

Access to surgery was ''appalling'', he said The service also
had IT issues, through lack of access to GPs' electronic
information, Prof Walker said.

In addition, the service lacked a proper data system. Renal
patients generated huge amounts of information, and Prof
Walker had been seeking funding for years, unsuccessfully,
for a system to manage the risks this posed.

He said the board stood to reap about three times what it
spent if it invested more resources in the service. Prof
Walker said the home based dialysis model worked extremely
well in the South, where people did not want to take frequent
trips to Dunedin Hospital, especially when they lived in
outlying areas.

Patient services executive director Lexie O'Shea said better
IT links between hospital clinicians and GPs would be in
place in 12 to 18 months. Chief executive Carole Heatly said
the ninth theatre opening at Dunedin Hospital next week would
help reduce surgical waiting times.

She said the clinicians had also highlighted the need for the
board to develop a proper day surgery service.